Original Article

Relationship of Chronic LBP (Low Back Pain) with Hamstring

Tightness in Professionals
Farwah Batool, Fatima Muaaz, Komal Tariq, Nazia Sarfraz
ABSTRACT
OBJECTIVES: To find out the relationship between chronic LBP (Low back pain) and hamstring
tightness in professionals.
METHODOLOGY: This was a cross sectional study. The sample size was 150 subjects. Data was
collected from Allied Hospital and DHQ Hospital Faisalabad. Male and female both were selected who
were High grade professionals (Engineer, Doctor, Businessman) Low grade professionals (Teacher,
Bankers), House wife and house husband working in home or hotel. Oswestary disability questionnaire
was used to determine the percentage disability in different professionals. Active Knee extension (AKE)
test was used for hamstring tightness. Chi square test for independence is used to determine the
relationship between chronic low back pain and hamstring tightness in professionals. SPSS was used
for analysis of results.
RESULTS: About 28% (42) respondents with moderate disability have hamstring tightness and 19% (29)
respondents with severe disability have hamstring tightness (P=0.004). Disability percentage has
relationship with activities of daily living. Subjects with active life style i.e. involve in different type of
activities such as physical activity and exercise or physical work have tight hamstring (P˂0.003).
Majority of housewife and house man have tight hamstring so chi square test shows that subject with
different level of profession with back pain have hamstring tightness (P˂ 0.001).
CONCLUSION: Study indicates that subjects interlinked with different professions (High grade profes-
sion, Low grade profession, Housewife, house husband and peon, sweepers) with back pain have tight
hamstring muscle. House wife and house husband are most commonly affected.
Key words: Chronic back pain, Hamstring tightness, Professionals
This article may be cited as: Batool F, Muaaz F, Tariq K, Sarfraz N. Relationship of Chronic LBP (Low Back
Pain) with Hamstring Tightness in Professionals. J Liaquat Uni Med Health Sci.
2019;18(03):236-40. doi: 10.22442/jlumhs.191830634
INTRODUCTION possibility factors of back pain, i.e. gender and age,
occupation, body distribution, smoking addiction, life
Chronic pain is characterized by unpleasant physical
habits, economic status and social status6. Chronic
sensations in one or more than one body region that
low back pain is one of the mutual reasons of
remain beyond the three months and related with
absenteeism from jobs. Teaching is a profession that
notable mental suffering or dysfunction result in
is responsible for increased incidence of chronic LBP6.
limitation in daily life activities and social life¹. Episode
LBP is a community health issue and is a frequently
of low back pain are common between professionals2.
reason of work related problem between different
Low back pain is the reason of worldwide disability as
professionals.7 Mechanical accident or danger in the
compared to any other condition and rank uppermost
different working area including hospital cause low
in case of disability (Years lived with disability –YLD)
back pain from lifting different things in different
and 6th in terms of overall burden DALY (Disability
professionals8. Personal, physical, psychosocial risk
Adjusted Life Years)3. According to systematic review
factor and ergonomic stressors are all linked to work
for the global burden of disease 2010 study, the
related back pain. Chronic low back pain is more
worldwide point prevalence of low back pain was 9.4%
common in teaching staff administration9. Mutual
and in some areas of the world as high as 15.0%
relationships, physical symptoms such as pain,
(North Africa/ Middle East 14.8%, Western Europe
fatigue, problems functioning, all are psychosocial
15.0%)4. According to 2015 data, highest ratio of low
factors that causes low back pain in professionals or
back pain that result in activity limitation was 7.3% in
limit their activities10. Long standing, incorrect back
Nordic Carolina. Mostly forty five million populations
posture, psychosocial issues, rhythmic movements for
were influenced by low back pain. LBP is the major
prolonged period, repeated heavy weight carrying all
reason of dysfunction worldwide5. Epidemiological
causes decreased life quality as well as occurrence of
studies give essential information relating to many

J Liaquat Uni Med Health Sci JULY-SEPTEMBER 2019; Vol 18: No. 03 236
Relationship of Chronic LBP
chronic LBP10. Pain worsen due to prolonged standing
specifically in persons who previously have back pain
because in these individual’s pattern of activation of
low back muscles is altered owing to the activation of
pain and spasm cycle11. Over utilization of body parts,
abnormal posture, height, sex, weight and high
intensity of working, mental and emotional strain all
these factors cause musculoskeletal disorder and low
back pain12. Hamstring muscles in lumbar flexed
position maintain the spinal curve. If hamstring
muscles flexibility is limited it produced more flexion at
the spinal level in the slumped sitting position which
leads the LBP and sufficient injury13. Muscular
endurance and power were found to be strongly
related to chronicity of back pain14. Chronic LBP is
most frequently reason of absence from work, people
are also in fear that if they do any activity or work it
could cause back pain, so they prefer to do sick leave.
Moreover, inactivity, people avoid exercise and other
recreational activities due to the concern that it will
lead to back pain and shortening of hamstring muscle.
Chronic Low back pain has been become a common
symptom and a major health concern in productive
age for both males and females in developing
countries. Work related characteristics may lead to
wide range of musculoskeletal problems, particularly
LBP. Many risk factors that cause back pain are
mentioned in literature. Literature on hamstring
flexibility that has linked to low back pain is not
available in professionals. So, the purpose of this
study was to determine whether hamstring tightness
has linked with low back pain or not among different
professionals.
METHODOLOGY
This was a cross sectional study. Purposive sampling
was used for data collection. Total sample size was
150 subjects. Data was collected from DHQ Hospital
and Allied hospital Faisalabad. Study was carried out
from June-September 2017. All individuals of
population belong to different professions had chronic
low back pain were contacted for collection of data
and for testing of hypothesis. Consent forms were
signed from all subjects. Screening form filled by the
individuals that were included in this study for
maximum variable and factors which were needed for
the result of this study Those individuals who did not
fulfil the requirement of inclusive criteria were not
included in this study. Age > 20 years, chronic LBP
subjects which last > 3 months, both males and
females that were belong to high grade professional,
low grade profession, housewife, house husband and
others (peon and sweepers), those females who were
not pregnant and obese were considered in inclusion
criteria. Those subjects above 55 years, less than 20
J Liaquat Uni Med Health Sci JULY-SEPTEMBER 2019; Vol 18: No. 03
years, any systemic diseases or underlying pathology,
any earlier history of operation, Acute LBP, pregnant
females, psychological disorder, congenital deformity
were excluded from study. All subjects completed the
questionnaire and all scientific, medical terms were
explained in a clear and simple way.
The primary outcome was chronic LBP the subjects
who had back pain for last more than 3 months. A test
was used to find out the hamstring muscle tightens
which is known as Active Knee Extension15 and
Oswestry LBP Disability Questionnaire (OLBPDQ)
was used for LBP disability. This questionnaire
indicates 0% to 20% is considered as minimal
disability, 21% to 40% is considered moderate
disability, 41% to 60% considered as severe disability,
and 61% to 80% is considered as crippled and 81 to
100% is considered as complete disability/ bed
bound16. SPSS 24 was used for analysis of data17.
RESULTS
There were total 150 participants included in this study
in which 65(43%) were males and 85(57%) were
females. Basic characteristics of participants were
shown in Table I. 106(71%) subjects have hamstring
tightness and 44(29%) have no hamstring tightness.
Out of 150 subjects 14 % (21) subjects had
insignificant disability (0% - 20%), 28% (42) had
moderate disability (21% - 40%), 19 %( 29) had
severe disability (41%-60%), 8 %( 12) had crippled
disability (61%-80%) and 1% (2) had complete
disability (81%-100%) on Oswestry LBP (Low back
pain) Disability questionnaire, as shown in Table II
females were more affected with LBP disability than
males. About 28%(42) subjects with moderate
disability had hamstring tightness and 19% (29)
subjects with severe disability had hamstring tightness
so chi square test had showed the relationship
between hamstring tightness and percentage disability
in professionals (back pain score) (p ˂ 0.004) Table II.
Chi square test was applied to find out the relationship
between hamstring muscles tightness and different
activities of routine life, the p values for hamstring
muscle tightness and activities of daily living such as
pain intensity, lifting, walking, sitting, standing,
sleeping, personal care were less than selected alpha
(α =0.05) which means that there was association
between hamstring tightness and these activities of
daily living except sex life, (p=0.052) social life (0.054)
and travelling (0.17) in professionals Table III. Forty
seven percent (70) subjects with active life style had
hamstring tightness and Twenty four percent (36) with
sedentary life style had hamstring tightness so there
was a significant relationship between hamstring
tightness and life style of professionals Table IV. Five
percent (7) subjects with high grade professional had
237
Farwah Batool, Fatima Muaaz, Komal Tariq, Nazia Sarfraz

hamstring tightness, Fourteen percent (9) subject with TABLE IV: RELATIONSHIP BETWEEN HAMSTRING
low grade professional had hamstring tightness, Forty TIGHTNESS AND LIFE STYLE OF PATIENTS
nine percent (74) house wife and house husband had
Active Sedentary Total P value
hamstring tightness, Seven percent (11) subject with
other professional had hamstring tightness therefore Active knee extension test for hamstring
result showed that there was a relationship between tightness
hamstring tightness in individual with back pain and Positive 70(47%) 36(24%) 106(71%) P˂0.003
their professions shown in Table V.
Negative 39(26%) 05(3%) 44(29%)
TABLE I:
BASIC CHARACTERISTICS OF PARTICIPANTS Total 109(73%) 41(27%) 150(100%)

Gender TABLE V: RELATIONSHIP BETWEEN

Male 65(43%) PROFESSION OF PATIENTS AND ACTIVE KNEE
Female 85(57%) EXTENSION TEST FOR HAMSTRING TIGHTNESS
Age Positive Negative Total P value
25 or under 19 (12.7%) Profession of patients
26-40 62 (41.3%)
High Grade
41-55 68 (45.3%) Profession
07(5%) 04(3%) 11(7%)

Life style Low Grade

14(9%) 14(9%) 28(19%)
Active 109(72.7%) Profession
P˂0.001
Sedentary 41(27.3%) House Wife /
74(49%) 12(8%) 86(57%)
House Husband
Socioeconomic status
Upper class 14(9.3%) Others 11(7%) 14(9%) 25 (17%)
Middle class 82(54.7%) 150
Lower class 52(34.7%) Total 106(71%) 44(29%)
(100%)

TABLE II: RELATIONSHIP BETWEEN HAMSTRING TIGHTNESS AND PERCENTAGE DISABILITY OF

PATIENTS
Insignificant Moderate Severe Complete Severe
Crippled
disability disability disability disability Total P values
(61-80%)
(0-20%) (21-40%) (41-60%) (81%-100%)
Active knee extension test for hamstring tightness
Positive 21(14%) 42(28%) 29(19%) 12(8%) 02(1%) 106(71%)
P ˂ 0.004
Negative 22(15%0 13(9%) 05(3%) 04(3%) 0 44(29%)
Total 43(29%) 55(37%) 34(23%) 16(11%) 02(1%) 150(100%)

TABLE III: DESCRIPTIVE STATISTICS FOR DIFFICULTY DISCUSSION

LEVEL OF DIFFERENT ACTIVITY OF DAILY LIVING
This study show that subjects of different professions
Mean Standard
Section names P value had complaint of chronic back pain and their
score deviation
hamstring muscle were tightened. Housewives are
Pain intensity 2.5 1.04 0.004
usually affected with this condition. Life style
Personal care of patients 2.67 1.13 0.058 commonly adopted lead to back pain and hamstring
Lifting 3.58 1.49 0.02 tightness. Activities of the daily living such as lifting
Walking 2.52 1.20 0.03 walking etc. affect their hamstring muscles and
causes back pain. Krol A 201714 determined the
Sitting 3.18 1.11 0.003
relationship between mechanical factors and pelvic tilt
Standing 3.36 1.23 0.003 in adults with and without LBP they were included
Sleeping 1.87 1.01 0.014 total 60 female students where the average age was
Sex life 3.30 2.23 0.052 22 years, the result of this study shows that subjects
Social life 2.73 1.33 0.054 with or with pain vary in terms of age P<0.001. There
was a significant relationship between pelvic tilt and
Travelling 2.90 1.23 0.17

J Liaquat Uni Med Health Sci JULY-SEPTEMBER 2019; Vol 18: No. 03 238
Relationship of Chronic LBP
LBP (R2=0.007 P=0.049) and lumber lordosis
(R2=0.13 P=0.02). They also explained that position
of pelvis depends on age, MI and angle of lumber
lordosis.
This current study result shows that chronic low back
pain cause hamstring tightness in professionals
(P˂0.004). Fasuyi FO 201718 had evaluated the
hamstring muscle length and pelvic tilt range between
subject with or without LBP. The study involved the 30
subjects with LBP and 30 subjects without LBP.
Subjects pelvic tilt range measured with digital
inclinometer and hamstring tightness measured with
active knee extension test. Subject without LBP had
longer hamstring muscle length (P=0.01) as compared
to subjects with LBP. Pelvic tilt range was not different
in both groups. Hamstring muscle length and pelvic tilt
range had no correlation in subject with or with LBP.
Pelvic tilt range was increases as hamstring. This
current study showed that chronic low back pain had
association with hamstring tightness (P>0.004). Patel
M 201819 determine the trunk flexibility strength and
endurance in physiotherapy student they indicate that
mean of back extension range was (3.52±1.19) cm
and back flexion range was (6.84+1.54) cm. Median of
manual muscle technique of upper back extensors
was 4 lower back extensors was 3 upper back flexors
was 4 and lower back flexor was 3. Mean of back
extensor endurance was (93±46.01) sec and mean of
back flexor endurance was (58.73±36.25) sec. Mean
of left hamstring was (150.94±13.4) degree and mean
hamstring flexibility was (149.59±13.81) degree.
Strength and hamstring flexibility were less in this
student than normal. Trunk flexibility was normal.
Endurance was below to average, and all these
factors lead to back pain. This current study result
showed that hamstring tightness was the cause of
chronic low back pain and functional disability in
professionals (P˂0.001). Arab AM 201420 had
evaluated the effect of life style and working setting on
hamstring length and lumbar lordosis in subject with or
without pain. They were included 508 subjects. The
result of this study showed no significant difference
with life style and different work setting of subjects
with or without back pain. Hamstring muscle length
and lumbar lordosis both are not affected by life style
and different work settings. This study indicates
difference in hamstring muscle length and not shows
significant difference in lumbar lordosis in individual
with or without back pain. This study indicated that
subject life style had also lead to hamstring tightness
in chronic low back pain professionals (P˂0.003).
CONCLUSION
Current Study indicates that subject interlink with
different professions (high grade profession, low grade
J Liaquat Uni Med Health Sci JULY-SEPTEMBER 2019; Vol 18: No. 03
profession, housewife, house husband and others i.e.
peon and sweepers) with back pain have tight
hamstring muscle. House wife or house husband are
most commonly affected.
Further interventional study is necessary to manage
the hamstring tightness in individuals with back pain.
This research can be used at a government level to
find out the quality of health of different individuals
awareness to patients to save them from factors which
caused chronic LBP and hamstring tightness.
Experimental studies should be conducted for the
management of hamstring tightness in professionals.
Ethical permission: University of Faisalabad
approval letter No. TUF/HOS/DPT/784 dated
10.10.2018.
Conflict of interest: There is no conflict of interest.
Funding: Authors have no funding / financial support
from anyone.
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AUTHOR AFFILIATION:
Farwah Batool (Corresponding Author)
The University of Faisalabad
Institute of Physical Therapy
The University of Lahore, Punjab-Pakistan.
Email: farwahbatool6@gmail.com
Fatima Muaaz
The University of Faisalabad, Punjab-Pakistan.
Komal Tariq
The University of Faisalabad
Institute of Physical Therapy
The University of Lahore, Punjab-Pakistan.
Nazia Sarfraz
Assistant Professor
The University of Faisalabad, Punjab-Pakistan.
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